Hill–Sachs lesion

Post Dislocated shoulder MRI 01

HillSachsMark

Shoulder dislocation with Bankart and Hill-Sachs lesion, before and after reduction

Hill–Sachs lesion is a cortical depression or fracture located on the posterolateral head of the humerus. It is typically associated with anterior shoulder dislocations. The lesion occurs as a result of forceful impaction of the humeral head against the anteroinferior part of the glenoid when the shoulder is dislocated anteriorly. This condition is significant because it can contribute to recurrent shoulder dislocations and instability.

Etiology

The primary cause of a Hill–Sachs lesion is an anterior shoulder dislocation. During the dislocation, the humeral head impacts against the edge of the glenoid cavity, leading to a compression fracture of the bone. This type of injury is common in contact sports, such as football and rugby, and activities that may involve falls or sudden impacts, such as skiing or skateboarding.

Pathophysiology

When the shoulder dislocates anteriorly, the posterior aspect of the humeral head comes into contact with the anteroinferior rim of the glenoid. This impact can cause a compression fracture or indentation in the bone, known as a Hill–Sachs lesion. The size and location of the lesion can vary, and its presence is a risk factor for recurrent dislocations due to the loss of the normal spherical shape of the humeral head and the mechanical mismatch with the glenoid cavity.

Clinical Presentation

Patients with a Hill–Sachs lesion may present with a history of shoulder dislocation. Symptoms can include pain, especially with certain movements, and a feeling of instability in the shoulder. Physical examination may reveal limited range of motion, particularly in abduction and external rotation.

Diagnosis

Diagnosis of a Hill–Sachs lesion typically involves a combination of patient history, physical examination, and imaging studies. X-rays of the shoulder can show the lesion, but magnetic resonance imaging (MRI) is more sensitive in detecting the size and exact location of the defect. MRI can also provide information on associated injuries, such as damage to the rotator cuff or the presence of a Bankart lesion, which is a tear of the anteroinferior glenoid labrum often associated with anterior shoulder dislocations.

Treatment

The treatment of a Hill–Sachs lesion depends on the severity of the lesion and the level of shoulder instability. Non-surgical options may include physical therapy to strengthen the shoulder muscles and improve range of motion. In cases where there is significant instability or recurrent dislocations, surgical intervention may be necessary. Surgical options can include arthroscopic techniques to repair the defect or procedures to prevent recurrent dislocation, such as a Latarjet procedure, which involves transferring a piece of bone to the front of the glenoid to increase its depth.

Prognosis

The prognosis for individuals with a Hill–Sachs lesion varies depending on the size of the lesion and the presence of associated injuries. With appropriate treatment, many individuals can return to their previous level of activity. However, those with larger lesions or significant shoulder instability may have a higher risk of recurrent dislocations and may require surgical intervention to achieve stability.

See Also

• Shoulder dislocation
• Bankart lesion
• Rotator cuff
• Glenoid cavity